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Breast Cancer Facts & Figures 2019-2020

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Breast Cancer Facts & Figures 2019-2020 Contents Breast Cancer Basic Facts 1 Breast Cancer Risk Factors 12 Figure 1. Distribution of Female Breast Cancer Subtypes, Table 4. Factors That Increase the Relative Risk for Invasive Breast US, 2012-2016 2 Cancer in Women 13 Breast Cancer Occurrence 3 Breast Cancer Screening 20 Table 1. Estimated New DCIS and Invasive Breast Cancer Table 5. Mammography (%), Women 45 and Older, Cases and Deaths among Women by Age, US, 2019 3 US, 2018 21 Table 2. Age-specific Ten-year Probability of Breast Cancer Table 6. Mammography (%) by State, Women 45 Diagnosis or Death for US Women 4 and Older, 2016 22 Figure 2. Age-specific Female Breast Cancer Incidence Rates by Race/Ethnicity, US, 2012-2016 4 Breast Cancer Treatment 23 Figure 3. Female Breast Cancer Incidence (2012-2016) Figure 12. Female Breast Cancer Treatment Patterns (%), and Death (2013-2017) Rates by Race/Ethnicity, US 5 by Stage, US, 2016 24 Figure 4. Distribution of Breast Cancer Subtypes by What Is the American Cancer Society Doing Race/Ethnicity, Ages 20 and Older, US, 2012-2016 5 about Breast Cancer? 26 Figure 5. Female Breast Cancer Stage Distribution by Race/Ethnicity, Ages 20 and Older, US, 2012-2016 6 Sources of Statistics 30 Figure 6. Trends in Incidence Rates of Ductal Carcinoma References 32 In Situ and Invasive Female Breast Cancer by Age, US, 1975-2016 7 Figure 7. Trends in Female Breast Cancer Incidence Rates by Race/Ethnicity, US, 2001-2016 8 Figure 8. Trends in Female Breast Cancer Death Rates by Race/Ethnicity, US, 1975-2017 8 Table 3. Female Breast Cancer Incidence and Death Rates by Race/Ethnicity and State 9 Figure 9. Geographic Variation in Female Breast Cancer Death Rates by Race/Ethnicity, 2013-2017 10 Figure 10. Trends in Female Breast Cancer 5-year Relative Survival Rates by Race, US, 1975-2015 11 Figure 11. Five-year Breast Cancer-specific Survival Rates (%) by Stage at Diagnosis and Race/Ethnicity, US, 2009-2015 11 This publication attempts to summarize current scientific information Global Headquarters: American Cancer Society Inc. about breast cancer. Except when specified, it does not represent 250 Williams Street, NW, Atlanta, GA 30303-1002 404-320-3333 the official policy of the American Cancer Society. ©2019, American Cancer Society, Inc. All rights reserved, including the right to reproduce this publication or portions thereof in any form. Suggested citation: American Cancer Society. Breast Cancer Facts & For permission, email the American Cancer Society Legal Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019. Department at [email protected]. Breast Cancer Basic Facts What is breast cancer? How is breast cancer staged? Breast cancer is a group of diseases in which cells in The extent of the cancer and its spread at the time of breast tissue change and divide uncontrolled, typically diagnosis determines its stage, which is essential for resulting in a lump or mass. Most breast cancers begin in guiding treatment options and prognosis (prediction of the lobules (milk glands) or in the ducts that connect the disease outcome). The two main staging systems for lobules to the nipple. cancer are the American Joint Committee on Cancer (AJCC) staging system, typically used in clinical settings, and the Surveillance, Epidemiology, and End Results What are the signs and symptoms of (SEER) summary staging system, used for descriptive and breast cancer? statistical analysis of tumor registry data. The AJCC Breast cancer typically has no symptoms when the tumor system was recently updated (effective January 2018) to is small and most easily treated, which is why screening add prognostic stage groups.1 AJCC anatomic stage is is important for early detection. The most common based on extent of the cancer (in the breast, regional physical sign is a painless lump. Sometimes breast cancer lymph nodes, and distant spread), while prognostic stage spreads to underarm lymph nodes and causes a lump or also includes information on the presence of estrogen swelling, even before the original breast tumor is large receptors (ER), progesterone receptors (PR), levels of enough to be felt. Less common signs and symptoms human epidermal growth factor receptor 2 (HER2, a include breast pain or heaviness; persistent changes, such growth-promoting protein) and/or extra copies of the as swelling, thickening, or redness of the skin; and nipple HER2 gene (HER2+/HER2-), and grade (reflecting how changes, such as spontaneous discharge (especially if closely the cancer’s microscopic appearance looks like bloody), scaliness, or retraction. Any persistent change in normal breast tissue). In this document, we generally the breast should be evaluated by a physician. refer to the SEER summary stage except in the section on the description of breast cancer treatment (page 23), which references AJCC anatomic stage. How is breast cancer diagnosed? Breast cancer is typically detected either during According to the SEER summary stage system: screening, before symptoms have developed, or after a • In situ stage refers to the presence of abnormal woman notices a lump. Most masses seen on a cells that are confined to the layer of cells where mammogram and most breast lumps turn out to be they originated. benign (not cancerous). When cancer is suspected, tissue for microscopic analysis is usually obtained from a • Local stage refers to invasive cancer that is confined needle biopsy (fine-needle or larger core-needle) and less to the breast. often from a surgical biopsy. Selection of the type of • Regional stage refers to cancer that has spread to biopsy is based on multiple factors, including the size and surrounding tissue and/or nearby lymph nodes. location of the mass, as well as patient factors and preferences and resources. • Distant stage refers to cancer that has spread to distant organs and/or lymph nodes, including nodes above the collarbone. Breast Cancer Facts & Figures 2019-2020 1 What are the types of breast cancer? Figure 1. Distribution of Female Breast Cancer Subtypes, US, 2012-2016 In Situ HR-/HER2+ 4% Historically, ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS), also known as lobular neoplasia, HR-/HER2- were considered the two main types of in situ breast cancer. 12% However, LCIS is generally believed to be a benign condition associated with increased breast cancer risk, but without HR+/HER2+ 11% the potential to progress to invasive cancer, so it was removed from the latest edition of the AJCC breast cancer 2 HR+/HER2- staging system. DCIS, on the other hand, is a precursor 73% to invasive cancer, although not all DCIS progresses. In fact, DCIS sometimes grows so slowly that even without treatment it would not affect a woman’s health. Long-term studies have found that only 20%-53% of women with HR = hormone receptor, HER2 = human epidermal growth factor receptor 2. untreated DCIS are ultimately diagnosed with invasive Source: North American Association of Central Cancer Registries (NAACCR), 2019. breast cancer.3-5 DCIS patients who are premenopausal at ©2019, American Cancer Society, Inc., Surveillance Research diagnosis or who had their DCIS detected by palpation are at greater risk of being diagnosed with a future invasive carcinoma, representing about 15% of invasive breast 6, 7 breast cancer. During 2012-2016, DCIS represented 16% cancers.8 Tubular, mucinous, cribriform, and papillary 8 of all breast cancer diagnoses. carcinoma are rare breast cancer subtypes that are generally associated with favorable prognoses.9 See page 13 for additional information on DCIS and LCIS. Inflammatory breast cancer is an uncommon but Cancer Facts & More information can also be found in the aggressive type of breast cancer that is characterized by Figures 2015, Special Section: Breast Carcinoma In Situ . swelling and redness of the skin of the breast. Invasive Molecular subtypes Most (81%) breast cancers are invasive, or infiltrating, Breast cancer molecular subtypes are determined which means the abnormal cells have broken through the through gene expression analysis, a costly and walls of the glands or ducts where they originated and complicated process that is not currently standard grown into surrounding breast tissue. Although breast clinical practice. However, these subtypes can be cancer was historically referred to as a single disease, approximated using routine methods for clinical it is now considered a group of diseases, consisting of evaluation of biological markers (ER, PR, HER2, and four major molecular subtypes and at least 21 distinct sometimes others). Hormone receptor positive (HR+) histological subtypes (type of tissue in which the cancer cancers are those that test positive for ER or PR, or both. originates) that differ in risk factors, presentation, Information about grade and proliferation (rate of cell response to treatment, and outcomes. division) is also sometimes used to assign subtype. Histologic subtypes The four main molecular subtypes are described below. Histology is based on the size, shape, and arrangement of It is worth noting that there are overlaps between breast cancer cells. More than 75% of invasive breast categories and the clinical approximations do not cancers are now histologically categorized as “no special perfectly correspond to the molecular breast cancer type,” historically called “ductal” carcinomas.8 The most subtypes as described on the next page.10 common special histologic subtype is invasive lobular 2 Breast Cancer Facts & Figures 2019-2020 Luminal A (HR+/HER2-): This is the most common type majority (about 75%) of triple negative breast cancers fall of breast cancer (Figure 1) and tends to be slower-growing in to the basal-like subtype defined by gene expression and less aggressive than other subtypes. Luminal A profiling.13 Triple negative breast cancers have a poorer tumors are associated with the most favorable prognosis prognosis than other subtypes, in part because treatment in part because they are usually responsive to hormonal advances have lagged behind other molecular subtypes.
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